Even well into the Affordable Care Act’s (ACA) implementation, the latest flash point in a conflict between medical knowledge and dogmatic religious belief goes further than access to abortion; we’re now debating contraception.
Under the ACA, the Health Resources and Services Administration (HRSA) defines services that must be covered by qualified group health insurance plans offered by employers. These HRSA guidelines stipulate that the plans cover all FDA-approved contraceptive methods when prescribed by a provider. Thus, under this regulation, private employers are required to offer health insurance that includes coverage for FDA-approved contraception.
This requirement took effect January 1 and has sparked a fire-storm of legal challenges centered around the question of whether the First Amendment’s protection of religious freedom extends to employers the right not to offer health insurance that covers an essential preventive service for their employees.
The conflict between medical evidence and religious belief is not new. Women’s health has been subject to religious challenges for decades. What is increasingly troubling is that the conflict between religion and medicine in women’s health has shifted from more existential questions about when life begins relative to abortion to the assertion of biologically irrational and falsifiable claims about whether contraception bears any relationship to termination. The assertion of nonevidence-based policy seems to be increasingly accepted.
This latest round of efforts to challenge the contraception coverage requirement under the ACA is predicated on conflation between contraception, which by definition is prevention of pregnancy, and abortion, or termination.
Health insurance coverage is a benefit provided as part of a subsidized compensation package to employees—and an employee’s health and health care choices really shouldn’t be subject to employer intrusion.
For better or worse, insurance coverage shapes access to care and the health care market—and, until we realize a right to health care and a single-payer system in this country, employer-sponsored insurance will continue to play a significant role in the practice of medicine.
What’s at stake in this conflict between religion and medicine is patient autonomy and outcomes. In an effort to strike a balance, proposed regulations released by the Department of Health and Human Services require insurers, rather than employers, to assume the cost if employers object to covering contraception. The proposal, which is open to public comment through April 8, may be a step in the right direction toward compromise.
Dr. Elizabeth Wiley, a graduate of George Washington University School of Medicine and University of Michigan Law School, is AMSA’s national president.